Laboratory diagnosis of malaria Plasmodium spp.

Determination of Parasitemia

Determination of parasitemia can be done using both thick and thin smears.

Thick smears: The number of parasites/µl of blood is determined by enumerating the number of parasites in relation to the standard number of WBCs/µl (8000).

No. Parasites × (8000 ÷ No. WBCs counted) = No. parasites per µL of blood

Thin smears: The percent of infected RBCs is determined by enumerating the number of infected RBCs in relation to the number of uninfected RBCs. A minimum of 500 RBCs total should be counted.

(No. infected RBCs ÷ Total No. RBCs counted) × 100 = Percent Infected RBCs

Notes: • Multiply-infected RBCs are counted as one. • Gametocytes are not figured in calculations. Laboratory diagnosis of malaria Plasmodium spp.

Life Cycle of Plasmodium spp.

The malaria parasite life cycle involves two hosts. During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the human host . Sporozoites infect liver cells and mature into schizonts , which rupture and release merozoites . (Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can persist in the liver and cause relapses by invading the bloodstream weeks, or even years later.) After this initial replication in the liver (exo-erythrocytic schizogony ), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony ). Merozoites infect red blood cells . The ring stage trophozoites mature into schizonts, which rupture releasing merozoites . Some parasites differentiate into sexual erythrocytic stages (gametocytes) . Blood stage parasites are responsible for the clinical manifestations of the disease.

The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal . The parasites’ multiplication in the mosquito is known as the sporogonic cycle . While in the mosquito's stomach, the microgametes penetrate the macrogametes generating zygotes . The zygotes in turn become motile and elongated (ookinetes) which invade the midgut wall of the mosquito where they develop into oocysts . The oocysts grow, rupture, and release sporozoites , which make their way to the mosquito's salivary glands. Inocula- tion of the sporozoites into a new human host perpetuates the malaria life cycle .